Multicenter study comparing EUS-guided hepaticogastrostomy and ERCP for malignant biliary obstruction in patients with accessible papillae

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2024-07-18 DOI:10.1002/jhbp.12055

Takeshi Ogura, Hirotoshi Ishiwatari, Susumu Hijioka, Kotaro Takeshita, Junya Sato, Mamoru Takenaka, Tomohiro Fukunaga, Shunsuke Omoto, Nao Fujimori, Akihisa Ohno, Keiichi Hatamaru, Takaaki Tamura, Hajime Imai, Masanori Yamada, Akitoshi Hakoda, Hiroki Nishikawa, Masayuki Kitano

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引用次数: 0

Abstract

Background

One advantage of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is that it is difficult for reflux cholangitis, caused by duodenal pressure increasing due to duodenal obstruction, to occur. In addition, since stent deployment is performed away from the malignant stricture site, longer stent patency than with endoscopic retrograde cholangiopancreatography (ERCP) may be obtained. However, no study has previously compared EUS-HGS and ERCP for patients without duodenal obstruction or surgically altered anatomy. The aim of the present study was to compare clinical outcomes between EUS-HGS and ERCP in normal anatomy patients without duodenal obstruction.

Method

In the ERCP group, patients who initially underwent biliary drainage were included. In the EUS-HGS group, patients who underwent EUS-HGS due to failed biliary cannulation were included. Patients with an inaccessible papilla, such as with surgically altered anatomy or duodenal obstruction, were excluded.

Results

A total of 314 patients who underwent ERCP and EUS-HGS were enrolled in this study. Of the 314 patients, 289 underwent biliary stenting under ERCP guidance, and 25 patients underwent biliary stenting under EUS-HGS. After propensity score-matching analysis, the adverse event rate tended to be lower in the EUS-HGS group than in the ERCP group. Although overall survival was not significantly different between the EUS-HGS and ERCP groups (p = .228), stent patency was significantly longer in the EUS-HGS group (median 366.0 days) than in the ERCP group (median 76.5 days).

Conclusions

EUS-HGS had a lower adverse event rate, shorter procedure time, and longer stent patency than ERCP in cases of normal anatomy without duodenal obstruction.

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比较 EUS 引导下肝胃切除术和 ERCP 治疗可触及乳头的恶性胆道梗阻患者的多中心研究。

背景：内镜超声引导肝胃造口术（EUS-HGS）的一个优点是很难发生因十二指肠梗阻导致十二指肠压力升高而引起的反流性胆管炎。此外，由于支架植入是在远离恶性狭窄部位进行的，因此与内镜逆行胰胆管造影术（ERCP）相比，可以获得更长的支架通畅时间。但是，以前还没有研究比较过 EUS-HGS 和 ERCP 对没有十二指肠梗阻或手术解剖结构改变的患者的效果。本研究旨在比较 EUS-HGS 和 ERCP 对无十二指肠梗阻的正常解剖患者的临床效果：方法：ERCP 组包括最初接受胆道引流术的患者。EUS-HGS 组包括因胆道插管失败而接受 EUS-HGS 的患者。不包括无法进入乳头的患者，如手术改变解剖结构或十二指肠阻塞的患者：本研究共纳入了 314 名接受 ERCP 和 EUS-HGS 的患者。在这 314 例患者中，289 例在 ERCP 引导下进行了胆道支架植入术，25 例在 EUS-HGS 引导下进行了胆道支架植入术。经过倾向评分匹配分析，EUS-HGS 组的不良事件发生率往往低于 ERCP 组。虽然EUS-HGS组和ERCP组的总生存率无明显差异（p = .228），但EUS-HGS组的支架通畅时间（中位数366.0天）明显长于ERCP组（中位数76.5天）：结论：对于解剖结构正常且无十二指肠梗阻的病例，EUS-HGS 比 ERCP 的不良事件发生率更低、手术时间更短、支架通畅时间更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.